Implication of the Life-Sustaining Treatment Decisions Act on End-of-Life Care for Korean Terminal Patients
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Purpose Life-sustaining treatment (LST) decisions for patients and caregivers at the end-of-life (EOL) process are supported by the “Act on Hospice and Palliative Care and Decisions on LST for Patients at the EOL,” enforced in February 2018. It remains unclear whether the act changes EOL decisions and LST implementation in clinical practice. For this study, we investigated patients’ decision-making regarding LSTs during the EOL process since the act’s enforcement. Materials and Methods Retrospective reviews were conducted on adult patients who were able to decide to terminate LST and died at Seoul National University Hospital between February 5, 2018, and February 5, 2019. We examined demographics, who made the decisions, the type and date of documentation confirming patient's LST, and whether the LST was withheld or withdrawn. Results Of 809 patients who were enrolled, 29% (n=231) completed forms regarding LST themselves, and 71% (n=578) needed family members to decide. The median time from confirmation of the EOL process to death and from the Advance Statement to death were 2 and 5 days, respectively (both ranges, 0 to 244). In total, 90% (n=727) of patients withheld treatment, and 10% (n=82) withdrew it. We found a higher withdrawal rate when family members made the decisions (13.3% vs. 1.7%, p < 0.001). Conclusion After the act’s enforcement, withdrawing LSTs became lawful and self-determination rates increased. Family members still make 71% of decisions regarding LSTs, but these are often inconsistent with the patients’ wishes; thus, further efforts are needed to integrate the new act into clinical practice.
Abstract
Purpose Life-sustaining treatment (LST) decisions for patients and caregivers at the end-of-life (EOL) process are supported by the “Act on Hospice and Palliative Care and Decisions on LST for Patients at the EOL,” enforced in February 2018. It remains unclear whether the act changes EOL decisions and LST implementation in clinical practice. For this study, we investigated patients’ decision-making regarding LSTs during the EOL process since the act’s enforcement. Materials and Methods Retrospective reviews were conducted on adult patients who were able to decide to terminate LST and died at Seoul National University Hospital between February 5, 2018, and February 5, 2019. We examined demographics, who made the decisions, the type and date of documentation confirming patient's LST, and whether the LST was withheld or withdrawn. Results Of 809 patients who were enrolled, 29% (n=231) completed forms regarding LST themselves, and 71% (n=578) needed family members to decide. The median time from confirmation of the EOL process to death and from the Advance Statement to death were 2 and 5 days, respectively (both ranges, 0 to 244). In total, 90% (n=727) of patients withheld treatment, and 10% (n=82) withdrew it. We found a higher withdrawal rate when family members made the decisions (13.3% vs. 1.7%, p < 0.001). Conclusion After the act’s enforcement, withdrawing LSTs became lawful and self-determination rates increased. Family members still make 71% of decisions regarding LSTs, but these are often inconsistent with the patients’ wishes; thus, further efforts are needed to integrate the new act into clinical practice.
참고문헌 (28)
- Lee SJ, "Discrepancies between patient and physician estimates for the success of stem cell transplantation", JAMA, 285, pp.1034~1038 (2001)
- Matsuyama R, "Why do patients choose chemotherapy near the end of life? A review of the perspective of those facing death from cancer", J Clin Oncol, 24, pp.3490~3496 (2006)
- 최연악, "Cancer Treatment near the End-of-Life Becomes More Aggressive: Changes in Trend during 10 Years at a Single Institute", Cancer Research and Treatment, 47(4), pp.555~563 (2015), 대한암학회[DOI]
- Farber SJ, "Issues in end-of-life care : patient, caregiver, and clinician perceptions", J Palliat Med, 6, pp.19~31 (2003)
- Grunfeld E, "Family caregiver burden : results of a longitudinal study of breast cancer patients and their principal caregivers", CMAJ, 170, pp.1795~1801 (2004)
- Singer PA, "Quality end-of-life care : patients'perspectives", JAMA, 281, pp.163~168 (1999)
- Oh DY, "CPR or DNR? End-of-life decision in Korean cancer patients : a single center's experience", Support Care Cancer, 14, pp.103~108 (2006)
- Kim DY, "Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea", J Palliat Med, 10, pp.1153~1158 (2007)
- 조현정, "Changes of End of Life Practices for Cancer Patients and Their Association with Hospice Palliative Care Referral over 2009-2014: A Single Institution Study", Cancer Research and Treatment, 52(2), pp.419~425 (2020), 대한암학회
- 백선경, "The Association between End-of-Life Care and the Time Interval between Provision of a Do-Not-Resuscitate Consent and Death in Cancer Patients in Korea", Cancer Research and Treatment, 49(2), pp.502~508 (2017), 대한암학회
- Lee JK, "Surrogate decision-making in Korean patients with advanced cancer : a longitudinal study", Support Care Cancer, 21, pp.183~190 (2013)
- "Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life, No. 14013(Feb 3, 2016)", ~ (2016)
- Hui D, "Concepts and definitions for "actively dying,""end of life," "terminally ill," "terminal care," and "transition of care": a systematic review", J Pain Symptom Manage, 47, pp.77~89 (2014)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Do Yeun Kim, "An Evaluation of Nutrition Support for Terminal Cancer Patients at Teaching Hospitals in Korea", Cancer Research and Treatment, 38(4), pp.214~217 (2006), 대한암학회
- Yun YH, "Experiences and attitudes of patients with terminal cancer and their family caregivers toward the disclosure of terminal illness", J Clin Oncol, 28, pp.1950~1957 (2010)
- Park HY, "Attitudes of the general public, cancer patients, family caregivers, and physicians toward advance care planning : a nationwide survey before the enforcement of the life-sustaining treatment decision-making act", J Pain Symptom Manage, 57, pp.774~782 (2019)
- 유신혜, "The Effect of Hospice Consultation on Aggressive Treatment of Lung Cancer", Cancer Research and Treatment, 50(3), pp.720~728 (2018), 대한암학회
- Levin TT, "How do-not-resuscitate orders are utilized in cancer patients : timing relative to death and communication-training implications", Palliat Support Care, 6, pp.341~348 (2008)
- van der Heide A, "End-of-life decision-making in six European countries : descriptive study", Lancet, 362, pp.345~350 (2003)
- Sprung CL, "Worldwide similarities and differences in the foregoing of life-sustaining treatments", Intensive Care Med, 22, pp.1003~1005 (1996)
- Way J, "Withdrawing life support and resolution of conflict with families", BMJ, 325, pp.1342~1345 (2002)
- Phua J, "Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia", JAMA Intern Med, 175, pp.363~371 (2015)
- 공봉한, "Experience of Advance Directives in a Hospice Center", Journal of Korean Medical Science, 30(2), pp.151~154 (2015), 대한의학회
- 홍지형, "Adopting Advance Directives Reinforces Patient Participation in End-of-Life Care Discussion", Cancer Research and Treatment, 48(2), pp.753~758 (2016), 대한암학회
- 고수진, "Experiences and Opinions Related to End-of-Life Discussion: From Oncologists' and Resident Physicians' Perspectives", Cancer Research and Treatment, 50(2), pp.614~623 (2018), 대한암학회
- 손경희, "Patient-Centeredness during In-Depth Consultation in the Outpatient Clinic of a Tertiary Hospital in Korea: Paradigm Shift from Disease to Patient", Journal of Korean Medical Science, 34(15), pp.1~9 (2019), 대한의학회
- Wright AA, "Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment", JAMA, 300, pp.1665~1673 (2008)